Identifying a low-flow phenotype in heart failure with preserved ejection fraction

a secondary analysis of the RELAX trial

Kershaw V. Patel, Rina Mauricio, Justin L Grodin, Colby Ayers, Gregg C. Fonarow, Jarett D Berry, Ambarish Pandey

Research output: Contribution to journalArticle

Abstract

Aims: The relationship between resting stroke volume (SV) and prognostic markers in heart failure with preserved ejection fraction (HFpEF) is not well established. We evaluated the association of SV index (SVI) at rest with exercise capacity and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in stable patients with HFpEF. Methods and results: Participants enrolled in the Phosphodiesterase-5 Inhibition to Improve Clinical Status and Exercise Capacity in Diastolic Heart Failure (RELAX) trial with available data on SVI by the Doppler method were included in this analysis (n = 185). A low-flow state defined by resting SVI < 35 mL/m 2 was present in 37% of study participants. Multivariable adjusted linear regression analysis suggested that higher resting heart rate, higher body weight, prevalent atrial fibrillation, and smaller left ventricular (LV) end-diastolic dimension were each independently associated with lower SVI. Patients with low-flow HFpEF had lower systolic blood pressure and smaller LV end-diastolic dimension. In multivariable adjusted linear regression models, lower SVI was significantly associated with lower peak oxygen consumption (peak VO 2 ) and higher NT-proBNP levels at baseline, and greater decline in peak VO 2 at 6 month follow-up independent of other confounders. Resting LV ejection fraction was not associated with peak VO 2 and NT-proBNP levels. Conclusions: There is heterogeneity in the resting SVI distribution among patients with stable HFpEF, with more than one-third of patients identified with the low-flow HFpEF phenotype (SVI < 35 mL/m 2 ). Lower SVI was independently associated with lower peak VO 2 , higher NT-proBNP levels, and greater decline in peak VO 2 . These findings highlight the potential prognostic utility of SVI assessment in the management of patients with HFpEF.

Original languageEnglish (US)
JournalESC Heart Failure
DOIs
StatePublished - Jan 1 2019

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Heart Failure
Brain Natriuretic Peptide
Phenotype
Stroke Volume
Linear Models
Diastolic Heart Failure
Exercise
Type 5 Cyclic Nucleotide Phosphodiesterases
Blood Pressure
Oxygen Consumption
Atrial Fibrillation
Heart Rate
Body Weight
Regression Analysis

Keywords

  • Biomarkers
  • Fitness
  • Heart failure with preserved ejection fraction
  • Stroke volume

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Identifying a low-flow phenotype in heart failure with preserved ejection fraction : a secondary analysis of the RELAX trial. / Patel, Kershaw V.; Mauricio, Rina; Grodin, Justin L; Ayers, Colby; Fonarow, Gregg C.; Berry, Jarett D; Pandey, Ambarish.

In: ESC Heart Failure, 01.01.2019.

Research output: Contribution to journalArticle

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title = "Identifying a low-flow phenotype in heart failure with preserved ejection fraction: a secondary analysis of the RELAX trial",
abstract = "Aims: The relationship between resting stroke volume (SV) and prognostic markers in heart failure with preserved ejection fraction (HFpEF) is not well established. We evaluated the association of SV index (SVI) at rest with exercise capacity and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in stable patients with HFpEF. Methods and results: Participants enrolled in the Phosphodiesterase-5 Inhibition to Improve Clinical Status and Exercise Capacity in Diastolic Heart Failure (RELAX) trial with available data on SVI by the Doppler method were included in this analysis (n = 185). A low-flow state defined by resting SVI < 35 mL/m 2 was present in 37{\%} of study participants. Multivariable adjusted linear regression analysis suggested that higher resting heart rate, higher body weight, prevalent atrial fibrillation, and smaller left ventricular (LV) end-diastolic dimension were each independently associated with lower SVI. Patients with low-flow HFpEF had lower systolic blood pressure and smaller LV end-diastolic dimension. In multivariable adjusted linear regression models, lower SVI was significantly associated with lower peak oxygen consumption (peak VO 2 ) and higher NT-proBNP levels at baseline, and greater decline in peak VO 2 at 6 month follow-up independent of other confounders. Resting LV ejection fraction was not associated with peak VO 2 and NT-proBNP levels. Conclusions: There is heterogeneity in the resting SVI distribution among patients with stable HFpEF, with more than one-third of patients identified with the low-flow HFpEF phenotype (SVI < 35 mL/m 2 ). Lower SVI was independently associated with lower peak VO 2 , higher NT-proBNP levels, and greater decline in peak VO 2 . These findings highlight the potential prognostic utility of SVI assessment in the management of patients with HFpEF.",
keywords = "Biomarkers, Fitness, Heart failure with preserved ejection fraction, Stroke volume",
author = "Patel, {Kershaw V.} and Rina Mauricio and Grodin, {Justin L} and Colby Ayers and Fonarow, {Gregg C.} and Berry, {Jarett D} and Ambarish Pandey",
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T1 - Identifying a low-flow phenotype in heart failure with preserved ejection fraction

T2 - a secondary analysis of the RELAX trial

AU - Patel, Kershaw V.

AU - Mauricio, Rina

AU - Grodin, Justin L

AU - Ayers, Colby

AU - Fonarow, Gregg C.

AU - Berry, Jarett D

AU - Pandey, Ambarish

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Aims: The relationship between resting stroke volume (SV) and prognostic markers in heart failure with preserved ejection fraction (HFpEF) is not well established. We evaluated the association of SV index (SVI) at rest with exercise capacity and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in stable patients with HFpEF. Methods and results: Participants enrolled in the Phosphodiesterase-5 Inhibition to Improve Clinical Status and Exercise Capacity in Diastolic Heart Failure (RELAX) trial with available data on SVI by the Doppler method were included in this analysis (n = 185). A low-flow state defined by resting SVI < 35 mL/m 2 was present in 37% of study participants. Multivariable adjusted linear regression analysis suggested that higher resting heart rate, higher body weight, prevalent atrial fibrillation, and smaller left ventricular (LV) end-diastolic dimension were each independently associated with lower SVI. Patients with low-flow HFpEF had lower systolic blood pressure and smaller LV end-diastolic dimension. In multivariable adjusted linear regression models, lower SVI was significantly associated with lower peak oxygen consumption (peak VO 2 ) and higher NT-proBNP levels at baseline, and greater decline in peak VO 2 at 6 month follow-up independent of other confounders. Resting LV ejection fraction was not associated with peak VO 2 and NT-proBNP levels. Conclusions: There is heterogeneity in the resting SVI distribution among patients with stable HFpEF, with more than one-third of patients identified with the low-flow HFpEF phenotype (SVI < 35 mL/m 2 ). Lower SVI was independently associated with lower peak VO 2 , higher NT-proBNP levels, and greater decline in peak VO 2 . These findings highlight the potential prognostic utility of SVI assessment in the management of patients with HFpEF.

AB - Aims: The relationship between resting stroke volume (SV) and prognostic markers in heart failure with preserved ejection fraction (HFpEF) is not well established. We evaluated the association of SV index (SVI) at rest with exercise capacity and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in stable patients with HFpEF. Methods and results: Participants enrolled in the Phosphodiesterase-5 Inhibition to Improve Clinical Status and Exercise Capacity in Diastolic Heart Failure (RELAX) trial with available data on SVI by the Doppler method were included in this analysis (n = 185). A low-flow state defined by resting SVI < 35 mL/m 2 was present in 37% of study participants. Multivariable adjusted linear regression analysis suggested that higher resting heart rate, higher body weight, prevalent atrial fibrillation, and smaller left ventricular (LV) end-diastolic dimension were each independently associated with lower SVI. Patients with low-flow HFpEF had lower systolic blood pressure and smaller LV end-diastolic dimension. In multivariable adjusted linear regression models, lower SVI was significantly associated with lower peak oxygen consumption (peak VO 2 ) and higher NT-proBNP levels at baseline, and greater decline in peak VO 2 at 6 month follow-up independent of other confounders. Resting LV ejection fraction was not associated with peak VO 2 and NT-proBNP levels. Conclusions: There is heterogeneity in the resting SVI distribution among patients with stable HFpEF, with more than one-third of patients identified with the low-flow HFpEF phenotype (SVI < 35 mL/m 2 ). Lower SVI was independently associated with lower peak VO 2 , higher NT-proBNP levels, and greater decline in peak VO 2 . These findings highlight the potential prognostic utility of SVI assessment in the management of patients with HFpEF.

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KW - Fitness

KW - Heart failure with preserved ejection fraction

KW - Stroke volume

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